Provider Demographics
NPI:1851661565
Name:BENNETT MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:BENNETT MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:775-329-0799
Mailing Address - Street 1:2600 MILL ST
Mailing Address - Street 2:STE 600
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2195
Mailing Address - Country:US
Mailing Address - Phone:775-329-0799
Mailing Address - Fax:775-329-9682
Practice Address - Street 1:1812 W KETTLEMAN LN
Practice Address - Street 2:STE 3
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4209
Practice Address - Country:US
Practice Address - Phone:209-339-8953
Practice Address - Fax:209-339-8491
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENNETT MEDICAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC-0165268332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003316778Medicaid
NV0759880002Medicare NSC